Healthcare Provider Details

I. General information

NPI: 1619529021
Provider Name (Legal Business Name): BYUNG JU KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BROOKHURST RD STE 104
FULLERTON CA
92833-4492
US

IV. Provider business mailing address

1401 S BROOKHURST RD STE 104
FULLERTON CA
92833-4492
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-2828
  • Fax:
Mailing address:
  • Phone: 714-879-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: